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Adult Social Care

Volume 825: debated on Thursday 24 November 2022


Asked by

To ask His Majesty’s Government what assessment they have made of the Local Government and Social Care Ombudsman’s Annual Review of Adult Social Care Complaints 2021–22, published on 12 October, which said that social care is a “system with a growing disconnect between the care to which people are entitled and the ability of councils to meet those needs”.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and in so doing, I draw the attention of the House to my interests in the register.

The Government have noted the findings in the report. Our priority is for everyone who is entitled to adult social care services to get the right support they need, at the right time and in the right place. The Government recognise the immediate pressures adult social care is facing, which is why the Chancellor has announced up to £2.8 billion of additional funding in 2023-24 and £4.7 billion in 2024-25.

My Lords, the extra money is to be welcomed, but two years’ extra funding is not a viable and sustainable response to the problems facing the social care system. Does the Minister agree with the Conservative chair of the LGA Community Wellbeing Board, Councillor David Fothergill, who says:

“Adult social care will remain in a crisis state until a comprehensive plan is in place to fully fund the care needed”?

If he does, when will that comprehensive funded plan be forthcoming?

I think we all agree on the vital necessity of adult social care—I think the noble Lord has heard me say it many times from this Dispatch Box—and that is what the £2.8 billion and £4.7 billion are about over the two years. The noble Lord is correct that we need to look longer-term, because the whole health service and the care of our elderly are obviously dependent on us getting this right.

My Lords, the backlog of care assessments, estimated at 500,000 by ADASS, lies at the heart of the complaints coming through to the ombudsman. They are all about assessment delays for people and their carers, not enough funding or staffing to deliver those assessments that are agreed and failures in home care and care home support. The latest NHS figures show that 145,226 people in England have died waiting for social care over the past five years, and nearly 29,000 previous self-funders have made a new request for council social care support because they have depleted their funds. Can the Minister tell the House exactly what impact the 200,000 more care packages to be delivered in place of the two-year cap delay will have on the huge backlog of assessments and what percentage of the original money earmarked for social care this actually represents?

I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.

My Lords, has my noble friend read the report of this House’s Economic Affairs Committee entitled Social Care Funding: Time to End a National Scandal published some years ago? In particular, the point is made in the report that to try to fund social care by allowing for an increase in council tax is highly regressive and inequitable because the tax base of the local authorities is least where the demand is greatest.

I have not read the report, which was published a few years ago—I will always stand up and say when I have read something and when I have not, and will not pretend to have read something that I have not. But I am aware of the issue. I was a local councillor many moons ago and am aware of the issue of the narrow tax base on which we are sometimes asking to draw, so it is a much wider question. That is why I am glad that a lot of this funding has come from central government as a down payment towards that. As I have mentioned many times, I accept that we need to find some long-term solutions in this space.

My Lords, the question of pay is very important of course, but the other element is the respect and self-respect that a professional is due. That can come only if they have a nationally recognised training programme, qualification and registration, none of which they have. Will the noble Lord think about how we might achieve that? At least that will bring more people into the profession.

I agree with the noble Lord that we need to make this an appealing profession and, as the noble Lord says, that involves more than just pay. We know that retention is vital, so I agree that having it properly recognised professionally is the direction of travel. At the same time, I am very glad to say that, for a lot of the money we are talking about—the £2.8 billion next year, for instance—some 70% will trickle down into wages, so I am pleased that it will actually be felt in the pockets of the carers, which again will help with recruitment and retention.

Can my noble friend advise us what is in place from the Government to look into the necessary social care of those mental patients who have had to be discharged from institutions and elsewhere, where the history is a very poor one. I speak as a former mental health commissioner. I feel that it is very sad that the community is not able to take care of people who should not be in institutions but in the community. What are the Government doing about this?

I thank my noble friend. I think we agree that, where care can be considered and put in place in the community, that has to be the best place to do it. These funds are not just limited to care homes. The whole reason that they are allocated through local authorities is that it allows them to put the money where it is most needed in their local area. I have to say at this point that, despite all the issues we talk about, 89% of people are satisfied with the care they receive and 64% or so are very or extremely satisfied. In the context of all this, we have to recognise that the numbers are showing us that this is a service that people are satisfied with.

My Lords, in following up the question raised by the noble Lord, Lord Forsyth, perhaps the Minister could outline to us the ratio of spend over the next two years in relation to what is being raised from council tax and what is actually coming from the Exchequer.

Of the £2.8 billion increase next year, £1 billion is coming through the grant, with the other £1.8 billion available for the local authorities. In 2024-25, of that £4.7 billion, £1.7 billion is coming through the central grant.

My Lords, the Archbishops’ commission on social care, which will be publishing its report next year, is also concerned about the inequitable funding when funding is raised through council tax. Can the Minister indicate how central money will reduce this inequality to accessing care and whether the Government are doing any evaluation of that?

Obviously, the central grant is raised through general taxation and so is distributed and raised in the way we all know. We can all have a question as to what the balance should be between the two. At the same time, I think we all believe in localism and we all believe, as part of that, that local authorities are the best placed to make decisions. That means that they have some of those fundraising abilities, so they can put more funds into the area where it is required. Whether we have the balance right is something we need to keep under control, but right now the most pressing thing is putting in more money for next year and the year after, and I am very glad—and I hope the whole House will welcome—that we have committed to do that. We put our money where our mouth is to create 200,000 new care packages.

My Lords, surely the most pressing thing is the emergency winter fund to help remove and reduce delayed discharges this year. The Secretary of State for Health has said that he wants to reduce the bureaucracy, so why are the rules for accessing the emergency winter fund so complex that the Health Service Journal is full of local authority and senior NHS staff saying that they do not understand why the Government are insisting on this bureaucracy?

Believe me, I am no fan of complexity. At the same time, I want to make sure, as I am sure we all do, that the funding goes to the places of most need and is really being spent on the areas that it is being spent on. Having said that, I will take away those comments at face value and will look into the complexity because, clearly, that is in no one’s interest.

My Lords, the crisis in social care has been worsening since I was advising the Dilnot commission in 2011. What plans do the Government have to improve the situation rather than watch it deteriorate? Age UK estimates that there are about 2 million elderly people needing care who are not receiving it, so 200,000 care packages are hardly going to make enough difference.

I thank my noble friend. As the population grows older, we must look at how to cater for these areas. We have been having real-term increases year after year of 2.5%, and 22% by 2024-25 is a substantial increase by any measure. At the same time, satisfaction levels are high. Do we need to do more? Clearly, we need to keep up in this space.